Visual outcomes after topography-guided femtosecond LASIK in virgin eyes

Background: Laser vision correction has been established over the last 2 decades as a safe and effective intervention, with Laser-assisted in situ keratomileusis [LASIK], being one of the main techniques practiced globally. Femtosecond laser-assisted LASIK has become a popularized modification over the last decade and over the standard LASIK technique utilizing mechanical microkeratomes. A spherical ablation profiles performed by "wave front optimized" have been employed to reduce spherical aberration associated with myopic corrections

Aim of the Work: To evaluate the quality and efficacy of topography-guided femtosecond lasik in virgin eyes with myopia, hypermetropia and astigmatism

Patients and Methods: This comparative prospective study was conducted on 60 eyes of 30 Egyptian patients with comparing preoperative and postoperative outcomes. Eyes with myopia [-1.0 up to -8.0 diopters] or hypermetropia [+1.0 up to +5.0 diopters] or astigmatism [up to 5.0 diopters] or less. Eyes with central corneal thickness [CCT] of 500 microns or more. Eyes at risk for developing post-refractive corneal ectasia, such as keratoconus, keratoconus suspect, previous refractive surgery, corneal dystrophy, corneal guttae or opacities, any previous eye surgery e.g: pseudophakic patients, retinal detachment surgery, all eyes were normal for example no cataract, no glaucoma, no retinal pathology and no previous trauma

Results: Our study was performed on sixty eyes of thirty Egyptian patients. Sixty eyes of thirty patients underwent LASIK using T-CAT. Seventeen patients were females and thirteen were males. The average age of the patients was 24.8 year +/-5.45 standard deviation [SD]. The average spherical error was -3.09 D +/-2.33 SD. The average cylinder error was -1.02 D +/-1.02 SD

Conclusion: The results showed that there was statistically significant differences between preoperative BCVA and postoperative UCVA with a good safety and efficiacy profile with T-CAT lasik as no patient loss even one line and 80% of cases gaining at least one line postoperative. The surgery was associated with higher values of high order aberrations after surgery than before surgery

Early and short term postoperative outcome of mitral valve replacement in patients with rheumatic mitral valve disease at Assiut University Hospitals

Rheumatic heart disease and its consequent valvular lesions is a major health problem in Egypt. Mitral valve replacement [MVR] is a routine procedure in cardiac surgery with considerable benefits in terms of postoperative quality of life and survival. To assess early [30days] and short term [3-6 months] outcome of patients with mitral valve disease undergoing MVR in our locality. This study was conducted on 72 patients [46 women and 26 men, with mean age of 28.2 +/- 12 years] with rheumatic mitral valve disease underwent MVR at Assiut University Hospital from January 2005 to May 2007. Preoperative, operative, and postoperative data were prospectively collected and analyzed as regards structural and hemodynamic outcome using echocardiography with its all modalities. Also, postoperative morbidity and mortality were determined. Fifteen post-operative morbidity occurred in 12 patients [16.6%], 10 occurred early [<30 days] and 5 late [>30 days]. Early post-operative morbidity occurred due to non-valve related causes in 60% of cases as acute heart failure, cardiogenic shock and electrolyte disturbances, and in 40% of cases due to valve related causes as prosthetic valve thrombosis, early prosthetic valve endocarditis and periprosthetic valve leakage. All late post-operative morbidity were caused by valve-related causes as late prosthetic valve endocarditis, prosthetic valve thrombosis and periprosthetic valve leakage. The 30-day hospital mortality was 6.9% [n=5], 60% of deaths were due to non-valve related causes, and 40% with valve related causes were identified as independent risk factors. Late postoperative mortality occurred in 2.8% [n=2] and all of them were due to valve related causes. Mitral valve replacement for patients with rheumatic mitral valve disease offers I satisfactory early and short-term results with excellent symptomatic improvement. Our institutional surgical results are comparable to the international results regarding postoperative morbidity and mortality

Prevalence of extended spectrum beta lactamase producers in an Egyptian critical care center

To determine the existence of extended spectrum beta lactamase [ESBL] producing Gram negative bacilli [GNB], in an Egyptian critical care center [CCC], we conducted a study over a period of 14 months at Kasr El Aini hospital, Cairo University. We collected 340 samples from health care workers [HCWs], and from 50 patients who acquired infections during hospitalization. Susceptibility of all isolated GNB was done to cephalosporin's [e.g. ceftazidime, cefotaxime], aztreonam, aminoglycosides [e.g. amikacin, gentamycin, and tobramycin], ciprofloxacin, imipenem, piperacillin and other beta lactamase inhibitors. Out of 176 isolated GNB, 106 isolates [60.2%] were confirmed as ESBL producers, mostly Escherichia coli [E. coli, 34%] followed by Klebsiella species [spp.] [30.2%] and Pseudomonas spp. [24.5%]. The predominant hospital acquired infection was respiratory tract infection [RTI] [60.2%] followed by urinary tract infection [UTI] [15.9%]. ESBL producing E. coli were responsible for 23.6% of hospital acquired RTI followed by ESBL producing Pseudomonas spp. [21.7%] and ESBL producing Klebsiella spp. [15.1%]. On the other hand, ESBL producing E. coli and Klebsiella spp. were equally responsible for hospital acquired UTI. 80-90% of these ESBL producing GNB were sensitive to imipenem and 70-90% was sensitive to piperacillin/tazobactam. ESBL producing GNB were isolated from hands of HCWs. Plasmid profile analysis demonstrated that hands of HCWs play an important role in spread of ESBL producing GNB among patients. In conclusion, ESBL producing GNB exist in this Egyptian CCC [106/340, 31.2%]; and rational antibiotic guidelines are mandatory to minimize the problem along with infection control practices. Incorporating microbial genetic typing in infection control program is recommended

Pervalence of clinically significant neonatal jaundice and its relation to some risk factors in Minoufyia governorate

Hyperbilirubinemia is one of the most common problems encountered in newborns. Nowadays it was noticed to be seen more than before, representing an important medical, social, and economic health problem. A number of epidemiologic factors may exert their influence on increasing the occurrence of neonatal jaundice. To estimate the prevalence of neonatal jaundice in Minoufyia governorate using the judgment of Integrated Management of Childhood Illness [IMCI] project for the detection of clinically significant jaundice and to identify some of its risk factors with spotting light on the role of family physician in the management. This study was carried out on 300 fullterm and preterm neonates [153 males, and 147 females], selected from three hospitals and two Maternal and Child Health Centers in Shebin El Kom City and districts. The study design composed of two main parts: A cross sectional study [200 cases], to estimate the prevalence of jaundice among neonates [group I], and: A case control study [100 cases], to identify the important risk factors for occurrence of neonatal jaundice [group IIA, B]. The prevalence of clinically significant neonatal jaundice was 17%. Some neonatal risk factors were found to be significantly increased among jaundiced babies compared to controls: low birth weight, prematurity, and infection [P values 0.02, 0.01, and 0.001 respectively]. However in comparing, sex, breast feeding, cephalhematoma, the difference was found to be insignificant. As regard maternal factors, the use of oxytocin during first stage of labor, was the only significant risk factor [P value 0.01], however, maternal age, education, consanguinity, jaundice of previous sibling, intake of iron and tonics, abdominal ultrasound, and mode of delivery were insignificant factors. The most common cause of pathological jaundice was infection, and the most commonly used treatment was phototherapy. More cases were referred from primary health physicians [PHP] compared to specialists with a significantly earlier age at referral [3.7+ 0.21 days in cases referred from PHP and 5.45 + 0.31 days in those of specialists]. However the outcome of cases didn't differ significantly between cases referred from PHP compared to specialists. The prevalence of neonatal jaundice is high in Minoufyia. A significant relation was found between the occurrence of neonatal jaundice and some maternal and neonatal risk factors which need to be reevaluated on a larger scale. The clinical criteria of the IMCI project for diagnosis and referral of jaundiced newborn are very beneficial and need to be generalized and supported by a scheduled neonatal follow up early after birth